Healthcare Provider Details

I. General information

NPI: 1962338111
Provider Name (Legal Business Name): TERRY GLENN PACE JR. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: T. GLENN PACE

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BRONK ST
MONTE VISTA CO
81144-1135
US

IV. Provider business mailing address

127 BRONK ST
MONTE VISTA CO
81144-1135
US

V. Phone/Fax

Practice location:
  • Phone: 970-261-3521
  • Fax:
Mailing address:
  • Phone: 970-261-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024552
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: